Public Health Workforce
COVID-19 has shown the need for a large, well-trained public health workforce not only to control the current pandemic but also future emerging diseases and to address health disparities and other disease burdens. This report illustrates why it is imperative to address challenges and barriers to scaling up the public health workforce. Control of communicable diseases such as syphilis and TB, HIV epidemic, health education, diabetes, mental health disorders, substance use disorders, and environmental health are just some health threats facing the population and these can be addressed by public health workers. COVID-19 showed us all how capacities within public health and healthcare can be overwhelmed. Therefore, an adequate workforce is needed to help control the next potential outbreak in a timely and effective manner. The report concludes by stating that with a successful scale-up of the public health workforce, public health authorities will not have to make difficult trade-offs between essential programs like contact tracing and vaccination.
This cross-sectional study explores predictors of COVID-19 vaccine uptake in 950 adults in a rural college town in central Pennsylvania. The cross-sectional study examined vaccination attitudes, norms, past behaviors, and perceptions of safety and efficacy. Sociodemographic information was also collected. Results of the multivariate ordinal regression indicated that the strongest predictors of vaccine uptake were related to trust in the system evaluating the safety and efficacy of the vaccines. Local attitudes and perceptions also played a role with vaccine uptake intention. The strongest predictors were lack of information regarding long-term side effects and role of natural immunity. There were no associations with sociodemographic factors. The findings align with that of this Morbidity and Mortality Weekly Report which states that there are significant disparities in vaccination access and coverage (December 2020 – April 2021) in urban and rural areas (45.7% vs 38.9%) respectively.
Another Morbidity and Mortality Weekly Report discusses differences in vaccine administration by race and ethnicity in North Carolina. It is evident that COVID-19 has disproportionately affected African Americans and Hispanics. Specifically for North Carolina, deaths were 1.6 times higher among African Americans than their White counterparts and similar rates were seen with Hispanics. In order to ensure equitable access to vaccines, the North Carolina Department of Health and Human Services (NCDHHS) developed and implemented a strategy to prioritize vaccines to African Americans and Hispanics. The strategy involved mapping communities who had a large population that were 65+. Another important component of the approach was that the following expectation was set: the share of vaccines administered to African American and Hispanic people either matched or exceeded populations proportions. This was a successful strategy as from December 2020 –January 2021 to March 29–April 2021, the proportion of vaccines administered to African Americans increased from 9.2% to 18.7%, and the proportion administered to Hispanics increased from 3.9% to 9.9%. NCDHHS also advised vaccine providers about promoting shared accountability with providers for equitable distribution of COVID-19 vaccines . NCDHHS required that vaccine providers report race and ethnicity for each vaccine recipient and provided performance reports twice per month showing the provider-specific vaccine administration to each racial and ethnic group aged ≥16 years relative to population proportions. Overall, 17.2% (95% CI = 17.1%–17.2%) and 5.6% (95% CI = 5.6%–5.6%) of vaccines were administered to African Americans and Hispanics, respectively. The strategies listed below were used by NCDHHS and they proved to be successful and is a model that could be used by other states.
|Tailor efforts||1. Hold appointment slots for underserved populations. For example, reserve 40 out of 100 appointments based on community demographics to ensure these slots are filled with patients from underrepresented communities first. Note this on waiting lists or create different waiting lists to allow for this prioritization. Preferentially reach out to patients from underrepresented communities and schedule these slots before opening appointments to the general population.|
|2. Partner with subsidized housing organizations and offer on-site vaccination events with appointments planned and scheduled with housing partner.|
|3. Partner with trusted messengers in faith and other community organizations, including those that cater to seniors.|
|Mitigate barriers to accessing web-based scheduling systems||4. Print and prepopulate event tickets with time and date of vaccine slot; distribute in person to groups who meet the priority criteria; allow them to transfer their ticket to someone else who meets criteria in their place.|
|5. Ask partner organization to assist with scheduling appointments, conducting targeted outreach via phone or in person. If working with one partner or more, allow each partner organization to reserve a set number of slots to fill with prioritized populations.|
|6. Educate partners to serve as “vaccine ambassadors” to conduct outreach and let eligible groups know how to sign up for a vaccine appointment.|
|Mitigate physical and perceived barriers||7. Host vaccination event at a location that is easy to access through public transportation and familiar to participants.|
|8. When registering participants, ask how the person intends to travel to the site and help arrange and/or subsidize transport, if needed.|
|9. Extend vaccine event hours to the evenings and weekends to accommodate persons who are unable to take time off from work or those requiring transport from family members.|
|10. Do not request photo identification or proof of residency to be vaccinated or to schedule an appointment. The need for an identification card might be a barrier for many populations, including older adults, immigrants, and persons experiencing homelessness.|